TXT2STOP: A randomised controlled trial of a novel smoking cessation intervention using mobile phone text-messaging

We aim to test the effects of mobile phone based smoking cessation support on self reported smoking status verified using a biochemical test on a sample of saliva at six months. Smoking contributes to the death of one in two of those who continue to smoke past 35 years of age.
Mobile phones allow personalised smoking cessation support programmes to be delivered inexpensively wherever the person is located. The New Zealand STOMP (stop smoking with mobile phones) trial found a doubling in quit rates at six weeks but provided no reliable data on long term effects.
The Txt2stop intervention is based on the STOMP programme, modified for use in the UK. To modify the intervention, youth smoking cessation counsellors and 62 potential participants reviewed all text messages in a series of focus groups. We have already conducted a pilot study among 200 participants. We achieved 93% long term follow up. The short term results show a doubling of quit rate (24% vs. 10%).
The Txt2stop trial among 5800 participants will establish the impact of mobile phone based smoking cessation support.

Background: Most of those killed by tobacco started smoking as teenagers and smoking kills one in two of those who continue to smoke past 35 years of age. Over half of young smokers want to quit or cut down but there is no evidence of the long term efficacy of smoking-cessation interventions in young people. Mobile phones provide a new channel for individualised programmes to be delivered inexpensively wherever the person is located and are popular with young people. The STOMP (stop smoking with mobile phones) trial assessed the effectiveness of a text message-based smoking cessation intervention in New Zealand. The results show considerable promise, with a two-fold increase in reported quit rates at 6 weeks. However, limitations in this study compromised the validity of the results at 6 months.
Drawing on the input of youth smoking cessation counsellors, cognitive behavioural therapists, motivational interviewing trained smoking cessation counsellors and 62 potential participants who reviewed all text messages in a series of focus groups, we modified the STOMP intervention for the UK. A pilot RCT which addressed the limitations of the previous study has been conducted with 200 participants. We recruited the target of 200 participants within two weeks from the trial launch. We achieved 98% complete short term follow up. The early results show a doubling of quit rate (24% vs. 10%). The long term outcome response rate is currently 93% with data collection still ongoing. The Txt2stop trial is needed to provide robust information on the long-term effectiveness of text messaging smoking cessation support.

Aim: To reliably assess whether a package of mobile phone based support can improve smoking cessation rates at 6 months.

Methods: We will conduct a single-blind randomised controlled trial of the Txt2stop mobile phone based smoking cessation intervention. 5,400 participants aged 16 and over will be randomised to the intervention or control group by computer. The primary outcome is self-reported abstinence at 6 months, verified by salivary cotinine testing. All analyses will be based on the intention-to-treat principle. The difference between the proportions that have quit at different stages of follow-up will be assessed using the chi-square statistic, with estimation of relative risks, 95% confidence intervals and two-sided p-values.

Implications: If successful, the study will provide robust evidence of the long term effectiveness of a smoking cessation intervention delivered by mobile phone. This will have major public health implications for tobacco related mortality and morbidity.